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Re: Vivid Dreamer
Feb 14, 2009

Hey Doc,

You recently answered my question and ended with "Hope that helps" Well IT DID. I hesitated to ask you that question in this forum because its not exactly about Fatigue and Anemia tho I do suffer from both. I wanted to just follow up with one more question. I am African American. I know that african americans tend to have a different reaction to Atripla than non blacks and more severe side effects. Do you in your practice see a higher number of blacks having trouble and do you offer any added advice on the 2 hour after dinner rule when it comes to taking meds. I dont eat late night snacks and I never take the Atripla within a 2 hour window after dinner but I also dont really feel as tho my stomach is empty 2 hours later either. Just wondering. I will repost your reply below for your memory.

Thanks much

Dr. Frascino's Response

Hey there Vivid Dreamer,

I took Sustiva for about two weeks before having to discontinue it due to a severe allergic reaction. I didn't like the vivid dreams; rather I loved the vivid dreams! I remember waking my husband Steve (Dr. Steve, the expert in The Body's Tratamientos forum) in the middle of the night just to tell him what fun I was having in my frenetic but fabulous dream world. I was so disappointed when I had to discontinue that drug. (It reminded me of living in the early 70s!) Of course, I realize these "vivid dreams" are not always so pleasurable/desirable and in fact can be downright terrifying and exhausting. You are correct: Most Sustiva users experience these wild and wooly dreams when they first begin the drug and the dreams along with other Sustiva-related side effects ("brain fog," difficulty concentrating, etc.) tend to gradually subside over the first few weeks of therapy. If they don't subside after four weeks, chances are they never will. You also mention taking your Atripla two hours after dinner. We know from pharmacokinetic studies that when Sustiva is taken with food, especially fatty foods, there is an increase in the blood level of the drug. With increased blood levels there is a corresponding increase in Sustiva-related side effects. There is no danger in taking Sustiva with food and if someone is not bothered by side effects there is no reason for any food restrictions when taking the drug. Any chance you are taking Sustiva two hours after dinner but relatively close to a midnight snack consisting of, say, a dozen Krispy Kreme doughnuts and pint of Ben and Jerry's Chunky Monkey ice cream? OK, just checking.

I have seen several folks who reported no problems with Sustiva-induced dream-fantasies when they began treatment but noticed them a number of months later. Sometimes this was food related. Sometimes they had added a new drug or supplement to their regimen and there may have been a drug-drug or drug-supplement interaction. And sometimes we couldn't figure out any cause of the change. The good news is that most of these folks behaved just like those who developed symptoms when initially starting the drug. Their symptoms gradually subsided over a period of weeks. (One guy took eight weeks!) We have not had to switch anyone off the drug because of these late-onset vivid-dreams phenomena.

I realize being an action hero all night long can be exhausting. (We've all seen "The Dark Night" Batman movie.) However, things could be worse. You could be dreaming that you are the illegitimate love child of Dick Cheney and Ann Coulter. Now there's a nightmare that could land you in therapy for years. If you love the convenience of your one-pill-once-per-day regimen and the dreams are tolerable, I'd hold tight and see if they subside on their own. Alternatively you could consider using a mild sedative. That sometimes helps as well. Also check to see if anything else has changed in your routine. For instance, are you going to the gym in the evening after work rather than in the morning? Has your mother-in-law moved in with you? Things along those lines that might alter stress levels.

Hope that helps.

Response from Dr. Frascino

Hello,

I'm delighted my response was helpful to you. Sustiva side effects are extremely variable from person to person, despite race or gender. As I briefly mentioned in my initial post, I have recommended on occasion a mild sedative at night, which some folks with Sustiva-induced sleep disturbances have found extremely helpful. Ask your HIV specialist for a short-term trial of a benzodiazepine (a sedative in the Valium class of drugs). If your Sustiva side effects are keeping you from getting a good night's rest, this may well help suppress your dreams.

Good luck.

Dr. Bob

Atripla - Sustiva Side Effects Feb 8, 2009

Hello Doc,

I greatly enjoy your answers as they tend to be in depth. I wanted to run this one past you to get your reply.

I have been on Atripla now for about 6 months. I did not initially have the Sustiva related side effects of "vivid dreams" other than the first night UNTIL about a month or 2 ago. At one time the dreams were so intense that I could not rest because I felt as tho I was in an action movie all night long. Lately I have been using Lemon Balm as a relaxer and it appears that my dreams are getting lighter or perhaps im going thru a cycle but I also find myself being more tired during the day. I guess my question here doc is that as I read about the Sustiva side effects they seem to be intense at first and then taper off within 4 weeks or so after.. Have you had many patients like me who take Atripla and take MONTHS for these side effects to kick in and do you believe that if they take that long to start that they may perhaps take months to start to taper off? I have discussed this with my doctor and we are considering Truvada with a few other things however I love the idea of single dosing and when I look at the other side effects that I could experience such as diarrhea or stomach pains or vomiting etc which I have experienced NONE of.. I feel a little bad about complaining about "Dreams" which are not real when I might switch to something that bring me things that are very real. I always wait at least 2 hours after dinner so im fine there but im wondering if there is any chance these vivid dreams will taper off since they took so long to start in the first place. Any thoughts?

Thank you again

Response from Dr. Frascino

Hey there Vivid Dreamer,

I took Sustiva for about two weeks before having to discontinue it due to a severe allergic reaction. I didn't like the vivid dreams; rather I loved the vivid dreams! I remember waking my husband Steve (Dr. Steve, the expert in The Body's Tratamientos forum) in the middle of the night just to tell him what fun I was having in my frenetic but fabulous dream world. I was so disappointed when I had to discontinue that drug. (It reminded me of living in the early 70s!) Of course, I realize these "vivid dreams" are not always so pleasurable/desirable and in fact can be downright terrifying and exhausting. You are correct: Most Sustiva users experience these wild and wooly dreams when they first begin the drug and the dreams along with other Sustiva-related side effects ("brain fog," difficulty concentrating, etc.) tend to gradually subside over the first few weeks of therapy. If they don't subside after four weeks, chances are they never will. You also mention taking your Atripla two hours after dinner. We know from pharmacokinetic studies that when Sustiva is taken with food, especially fatty foods, there is an increase in the blood level of the drug. With increased blood levels there is a corresponding increase in Sustiva-related side effects. There is no danger in taking Sustiva with food and if someone is not bothered by side effects there is no reason for any food restrictions when taking the drug. Any chance you are taking Sustiva two hours after dinner but relatively close to a midnight snack consisting of, say, a dozen Krispy Kreme doughnuts and pint of Ben and Jerry's Chunky Monkey ice cream? OK, just checking.

I have seen several folks who reported no problems with Sustiva-induced dream-fantasies when they began treatment but noticed them a number of months later. Sometimes this was food related. Sometimes they had added a new drug or supplement to their regimen and there may have been a drug-drug or drug-supplement interaction. And sometimes we couldn't figure out any cause of the change. The good news is that most of these folks behaved just like those who developed symptoms when initially starting the drug. Their symptoms gradually subsided over a period of weeks. (One guy took eight weeks!) We have not had to switch anyone off the drug because of these late-onset vivid-dreams phenomena.

I realize being an action hero all night long can be exhausting. (We've all seen "The Dark Night" Batman movie.) However, things could be worse. You could be dreaming that you are the illegitimate love child of Dick Cheney and Ann Coulter. Now there's a nightmare that could land you in therapy for years. If you love the convenience of your one-pill-once-per-day regimen and the dreams are tolerable, I'd hold tight and see if they subside on their own. Alternatively you could consider using a mild sedative. That sometimes helps as well. Also check to see if anything else has changed in your routine. For instance, are you going to the gym in the evening after work rather than in the morning? Has your mother-in-law moved in with you? Things along those lines that might alter stress levels.

Hope that helps.

Dr. Bob


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